=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073642526
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEITH DAVIDSON WHITAKER LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | HC 1 BOX 5412
-----------------------------------------------------
City | KEAAU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96749-9530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-982-6503
-----------------------------------------------------
Fax | 808-982-6298
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC 1 BOX 5412
-----------------------------------------------------
City | KEAAU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96749-9530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-982-6503
-----------------------------------------------------
Fax | 808-982-6298
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 26
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------